Delayed, Type III Pattern Food Allergy

A Cause of Chronic Illness

The desire for simple, definitive tests for food allergy is easy to
understand, but difficult to fulfill.with
features of a recurrent flu-like syndrome. Gastrointestinal tract dysfunction
seems to be central to the pathogenesis of a variety of systemic manifestations.
The most common, milder manifestations involve IBS as the center of the type III
pattern and other diagnoses cluster around the central gastrointestinal tract
dysfunction - migraine, Fibromyalgia, fatigue, depression, chronic rhinitis,
sinusitis, asthma, and arthralgias are typical associations.

Knicker stated: "Delayed adverse reactions to foods are exceedingly varied, and
may involve virtually any organ system. Some reactions are classically allergic
and at times may reflect delayed IgE-mediated mechanisms. Others involve a
single organ system, or multiple organ systems (e.g. the central nervous system,
respiratory system, skin, musculoskeletal apparatus, gastrointestinal system,
cardiovascular system etc.) with puzzling combination of symptoms."

Mechanisms in delayed patterns of food allergy

the neuro-immunologic responses of the gastrointestinal tract with local
symptoms and broadcast of peptides and cytokines which produce systemic symptoms

the action of chemical mediators released by activated mucosal, circulating,
and tissue-bound immune cells

the activation of cell-mediated immunity involving mast cells, eosinophils
macrophages, lymphocytes and a host of cytokines.

Since this category of disease is based on a complex of pathophysiological
mechanisms, it contains a surprisingly large spectrum of disease. Considr three
categories of disorders:

Common recognized syndromes

Specific diseases

Nonspecific illness

Syndromes such as irritable bowel syndrome, migraine, panic disorder,
depression, chronic fatigue, fibrositis or fibromyalgia can be collected under
the title of type III pattern. All the rheumatic diseases, autoimmune diseases,
multiple sclerosis, type 1 diabetes, thyroiditis, Crohn's disease, psoriasis are
hypersensitivity diseases that can be included along with common specific
problems that are related to classical allergy - asthma, atopic dermatitis,
urticaria, anaphylaxis, angioedema, allergic gastroenteropathy, and allergic
arthritis.

Many of the ever-enlarging pool of patients who are not well but who do not
have the markers of specific can be included. Patients with in-between disease
have some of the symptoms and signs that suggest the diagnosis of specific
disease but not everything fits together. Most chronic diseases take many years
to evolve so that many in-between patients are on their way to the final disease
product.

The concept of delayed patterns of immune response ("food allergy") to food
materials provides both a theoretic and practical basis for interpreting
symptoms of patients with both specific diseases and non-specific syndromes. The
presence of food allergy (as a pathophysiological mechanism) is concealed in a
variety of nosological diagnoses such as migraine headaches, asthma, eczema,
irritable bowel syndrome, depression, panic disorder, and arthritis. These
syndromes tend to cluster in type III patients.

Serum Sickness Leads to Inflammation in Target Organs

Von Pirquet first described serum sickness, the prototype of Immune Complex
disease. Any food protein entering the circulation in sufficient quantity can
produce symptom patterns resembling serum sickness. Serum sickness manifests as
a systemic illness, typically evolving over a period of 7-10 days.
Manifestations include general malaise, fever, flushing, sweating, hives,
swelling, bruising, arthralgias and myalgias, progressing in the worst case to
inflammatory disease in target organs. Circulating immune complexes may lead to
inflammation in target organs. Type III events lead to Type IV hypersensitivity.
Flu-like or non-specific symptoms tend to become more specific disease as target
organ effects become manifest.

Type IV, cell-mediated immunity produces inflammation with local dysfunction,
associated with systemic symptoms from immune mediators released into the
bloodstream. If a macrophage-lymphocytic network is activated by food antigens
the pathogenic consequences depend on the dose, frequency, and distribution of
antigen, and the location of lymphocytes. The idea is that any part of the body
can be involved in an immune skirmish. The consequences depend on the importance
of the target organ the nature and extent of problems caused by immune activity.
Events in the nose will be experienced as discomfort. Events in the eye or other
critical areas of the brain may be catastrophic.

Systemic Lupus Erythematosis (SLE serves as a model of type III - IV patterns
of hypersensitivity disease. The typical type III syndrome is the systemic
flu-like illness with minimal evidence of target organ involvement. This
syndrome may include a malar or butterfly rash, flushing, lymphadenopathy,
arthralgias, headaches, fever, sweating, fatigue, dyspepsia, bloating, diarrhea.
Arthralgias are associated with generalized aching and stiffness (often
diagnosed as fibromyalgia) and infrequently joint swelling occurs. Mild
localized inflammation may be associated such as rhinitis, pharyngitis or
episodes of localized abdominal tenderness, especially in the right lower
quadrant. If the disease advances, increased evidence of target organ
inflammation and dysfunction becomes more apparent.

The Evolving Nature of Hypersensitivity

The delayed or type III pattern of food allergy is an evolving process over
time. Often there is a "background noise" of milder but chronic symptoms,
punctuated episodically by more acute events. This may be a life-long process
that begins with colic, rhinitis, recurrent otitis media and/or eczema in
infancy and progresses through different symptom patterns as the years go by. A
typical presentation of type III pattern food allergy involves symptoms emerging
in waves of dysfunction. A typical adult patient will present with recurrent
rhinopharyngitis, abdominal pain and bloating, generalized muscle-tension,
aching and stiffness with fatigue, weakness, and often cognitive dysfunction. In
any given patient, the mechanism of disease may not be demonstrable by objective
means especially when the disease is at an early stage of development and
dysfunction is relatively mild. Physical signs include flushing, allergic
shiners with suborbital edema, butterfly rash, rhinitis, enlarged cervical
nodes, increased skin telangiectasias, edema of hands and feet, muscle and
connective tissue tenderness with "trigger nodes", skin rashes, tender
costochondral junctions, and spot tenderness in the abdomen, most often RLQ and
LLQ.

None of this phenomenology would make sense without a standard method of diet
revision to reveal the food origin of the disease. Both patient and physician
must have the opportunity to demonstrate clearing of symptoms on an elemental
nutrient formula (Alpha ENF)and/or an oligoantigenic diet. Both must also have
the opportunity to study the patterns of returning symptoms when a reactive food
is again eaten.

The most important initial experiment is to require that a sick patient stop
eating the food that is making him ill long enough that the pathological
processes subside and symptoms clear. An elemental nutrient formula, free of
protein and peptide antigens can supply complete nutrition and allows a patient
to continue long enough to experience remission - 10 to 20 days is the expected
time of symptom clearing.

The Continuous Activity of Immune Networks

To develop a useful clinical understanding of hypersensitivity disease, it is
necessary to think of immune networks as continuously active in the human body.
A dynamic model of immune networks reveals that mobile cell populations produce
evanescent events that are continuously evolving. Immune cell populations moving
through boundaries that open and close and as immune networks become more
active, the migrations become more hectic and the boundaries become less secure;
events tend become turbulent or chaotic. Patients report the kind of events that
occur and can tell us about progression of symptoms and diseases over time.

Immune responses to food antigens depend on the dose of antigen,
distribution, timing, and frequency of antigen exposure and many other variables
related to the state of the host. Outside challenge (antigens) are disturbances
which ripple through immune networks, triggering a host of responses. Some of
these responses may be useful and others may disrupt normal function without any
benefit. Repeated challenges with the same stimulus will produce an array of
related responses; never just the same response.

If the basic assumption is that each challenge from the outside renders
immune networks temporarily hyperactive and unstable, it is possible understand
the experiences of patients who report a fascinating array of events with
different timing, duration, topology and consequences.

It is unlikely that one hypersensitivity mechanism cannot operate in
isolation from other mechanisms. Each challenge from the outside renders immune
networks unstable and may induce chaos if the challenge is sufficiently intense.
Some antigens may go beyond activating antigen-specific clones; these super
antigens may excite polyclonal cell populations, inducing general
hypersensitivity. Staphylococcal enterototoxins, for example, responsible for
food poisoning and toxic shock syndrome, act as super antigens and generally
activate immune networks.

The histories of patients presenting to my office illustrate the complexity
of these immune events over time. For example, one patient described 60 years of
immune-mediated disease beginning with childhood illnesses typical of delayed
pattern food allergy. Her sequence of major hypersensitivity diseases over 60
years was eczema, asthma, migraines, thyroid ( Grave's disease), fibromyalgia,
recurrent "pneumonias", and finally rheumatoid arthritis. Consider the
possibility that the whole sequence of hypersensitivity manifestations is linked
by a common, underlying pathophysiological process - this connected sequence
suggests the possibility that food antigens triggered a variety of immune
responses over-time.

The Food Allergy Center is devoted to explaining a complicated
subject. We offer rich resources online and encourage our readers to further
pursue their interest by reading our books. This is an educational
resource and order portal developed by Environmed Research Inc. Alpha Education books refer
to the Alpha Nutrition Programa standard method
of diet revision.

Managing Food Allergy

Stephen Gislason MD explains how
food allergy causes many diseases that can be corrected by using proper diet revision. Click download to order eBook

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